Abstract
AimsTo examine the feasibility, acceptability and preliminary cost‐effectiveness of a lay counsellor delivered psychological treatment for men with alcohol dependence in primary care.DesignSingle‐blind individually randomized trial comparing counselling for alcohol problems (CAP) plus enhanced usual care (EUC) versus EUC only.SettingTen primary health centres in Goa, India.ParticipantsMen (n = 135) scoring ≥ 20 on the Alcohol Use Disorder Identification Test (AUDIT). Sixty‐six participants were randomized to EUC and 69 to CAP + EUC.InterventionsCAP, a lay counsellor‐delivered psychological treatment for harmful drinking, with referral to de‐addiction centre for medically assisted detoxification. EUC comprised consultation with physician, providing screening results and referral to a de‐addiction centre.MeasurementsBaseline socio‐demographic data, readiness to change and perceived usefulness of counselling. Acceptability and feasibility process indicators such as data on screening and therapy. Outcomes were measured at 3 and 12 months post‐randomization and included remission, mean daily alcohol consumed, percentage of days abstinent (PDA), percentage of days of heavy drinking (PDHD), recovery, uptake of detoxification services, impacts of alcohol dependence, resource use and costs.FindingsParticipants in the CAP + EUC arm had more numerically but not statistically significantly favourable outcomes compared with those in the EUC arm for (a) remission at 3 months [adjusted odds ratio (aOR) = 1.95, 95% confidence interval (CI) = 0.74–5.15] and 12 months (aOR = 1.90, 95% CI = 0.72–5.00), (b) proportion of non‐drinkers at 3 months (aOR = 1.26; 95% CI = 0.58–2.75) and 12 months (aOR = 1.25; 95% CI = 0.58–2.64) and (c) ethanol consumption among drinkers at 3 months (count ratio = 0.91; 95% CI = 0.58–1.45) and 12 months (count ratio = 1.06; 95% CI = 0.73–1.54). There was no statistically significant evidence of a difference in the occurrence of serious adverse events between the two arms. From a societal perspective, there was a 53% chance of CAP + EUC being cost‐effective in achieving remission at 12 months at the willingness‐to‐pay threshold of $415.ConclusionsLay counsellor‐delivered psychological treatment for men with alcohol dependence (AD) in primary care may be effective in managing AD in low‐ and middle‐income countries. A definitive trial of the intervention is warranted.
Highlights
Alcohol dependence (AD), a cluster of behavioural, cognitive and physiological phenomena in which alcohol use takes on a much higher priority for an individual than other behaviours, has been linked to a high level of disability and economic burden and an elevated risk of mortality compared to the general population [1,2,3,4,5,6]
There is extensive evidence supporting the efficacy of brief interventions (BI) among people with non-dependent alcohol use disorders (AUD), there is a lack of evidence that BIs are effective for people with AD [19,20], and it is standard practice for those with AD to be referred for treatment in specialist services
A total of 66 participants were randomized to enhanced usual care (EUC) and 69 to counselling for alcohol problems (CAP) plus EUC (Fig. 1)
Summary
Alcohol dependence (AD), a cluster of behavioural, cognitive and physiological phenomena in which alcohol use takes on a much higher priority for an individual than other behaviours, has been linked to a high level of disability and economic burden and an elevated risk of mortality compared to the general population [1,2,3,4,5,6]. Despite the existence of effective treatment options for AD, the treatment gap for all forms of harmful drinking globally remains high (78%), especially in low- and middle-income countries (LMICs) including India, where the recent National Mental Health Survey reported a treatment gap of 86% [9,10,11]. There is growing evidence supporting the effectiveness of NSHW-delivered interventions for alcohol use disorders (AUD), including in LMICs such as Thailand, Kenya and India [14,15,16,17,18]. These interventions were designed to target hazardous and harmful drinking, not alcohol dependence. There is extensive evidence supporting the efficacy of brief interventions (BI) among people with non-dependent AUD, there is a lack of evidence that BIs are effective for people with AD [19,20], and it is standard practice for those with AD to be referred for treatment in specialist services
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